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California rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $174 · 10th–90th $138–$7940%20%10th90th$174Professionalmedian $182 · 10th–90th $138–$1,5490%20%10th90th$182$0.2$1.0$5.0$20.0$100.0$500.0$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $1,737.80
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $181.97 / $1,548.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $173.78 / $794.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $181.97 / $489.78
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $588.84 / $933.25
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$380.19 / $741.31 / $1,513.56
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $186.21
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $269.15 / $489.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $398.11 / $645.65
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,621.81 / $1,621.81 / $1,621.81
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,818.38 / $2,818.38 / $2,818.38
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $309.03 / $309.03
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $70.79
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $316.23 / $489.78
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $295.12
Sutter Health Plus
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $758.58
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $281.84 / $371.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$24.55 / $147.91 / $407.38
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $181.97 / $416.87